血浆脑钠素和心钠素在心力衰竭中的诊断价值及评价  

The value and evaluation of plasma BNP and ANP in diagnosis of heart failure

作　　者：朱雪明[1] 沈海英[1] 冯萍[1] 邵春来[2] 洪小苏[2] 

机构地区：[1]苏州大学第二附属医院检验科,215004 [2]苏州大学第二附属医院心血管内科,215004

出　　处：《中华检验医学杂志》2006年第10期923-925,共3页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨血浆脑钠素（BNP）、心钠素（ANP）浓度变化对心力衰竭的诊断价值。方法分别采用酶联免疫法和放射免疫法检测75例心力衰竭患者（NYHAⅡ～Ⅳ级）和25名健康对照者的血浆BNP和ANP浓度，同时采用纽约心脏病学会（NYHA）标准对心功能分级和用超声心动图检查评定患者心功能。结果心力衰竭组血浆BNP浓度为（1794．1±724．5）ng／L、ANP浓度为（948．5±520．7）ng／L，与正常对照组BNP（90．5±55．8）ng／L、ANP（121．7±71．1）ng／L比较差异有统计学意义（P〈0．01）。BNP浓度心功能Ⅱ级为（552．9±339．6）ng／L、Ⅲ级（1303．9±566．4）ng／L、Ⅳ级（3625．5±1069．2）ng／L，两两比较差异有统计学意义（P〈0．05）；ANP浓度Ⅱ级为（518．8±376．3）ng／L、Ⅲ级（1061．9±521．3）ng／L、Ⅳ Ⅴ级（1264．7±798．1）ng／L，Ⅱ级与Ⅲ级、Ⅳ级比较差异有统计学意义（P〈0．05），而Ⅲ级和Ⅳ级比较差异无统计学意义（P〉0．05）。左心室射血分数LVEF〉40％的患者BNP为（1096．7±656．6）ng／L、ANP为（931．6±320．9）ng／L，LVEF〈40％的患者BNP（2659．4±743．5）ng／L、ANP（974．3±555．6）ng／L，两组患者血浆BNP浓度差异有统计学意义（P〈0．05）；而ANP差异无统计学意义（P〉0．05）。BNP和ANP在受试者工作特征（ROC）曲线下的面积分别为0．97和0．85，两者曲线下面积差异有统计学意义（P〈0．01）。结论血浆BNP比ANP对心力衰竭患者的诊断具有更高的准确性，BNP与超声心动图反映的血流动力学状况指标LVEF及NYHA分级具有较好的相关性，可以作为心力衰竭分级的一个良好的诊断指标。Objective To evaluate the diagnosis value of plasma brain natriurefic peptide（BNP） and atrial natriuretic peptide （ANP） concentration in the patients with heart failure （HF）. Method Plasma BNP and ANP from 75 patients suffered from HF and 25 health controls were respectively determined by ELISA and Radioimmunassay. Meanwhile, the cardiac function were accessed by NYHA standard and electric cardigram. Results Plasma BNP （ 1 794. 1 ± 724. 5 ） ng/L and ANP （ 948.5 ± 520. 7 ） ng/L concentration of heart failure patients were obvious higher than that in the control group [ BNP （ 90. 5 ± 55.8 ） ng/L, ANP （121.7 ± 71.1 ）ng/L] （P 〈 0.01 ）. The BNP concentration in different NYHA [ NYHAⅡ （552.9 ± 339.6） ng/L, NYHAⅢ （ 1 303.9 ± 566. 4 ） ng/L, NYHAⅣ （3 625.5 ± 1 069.3 ） ng/L ] had statistical significance （P 〈 0. 05 ）. ANP concentration in NYHA Ⅱ（ 518. 8 ± 376. 3 ） ng/L was different from in NYHA Ⅲ（ 1 061.9 ± 521.4） ng/L and NYHAⅣ （ 1 264.7± 798. 1 ） ng/L （P 〈 0. 05 ）, but ANP concentration in NYHA Ⅲ and NYHAⅣ had no significant difference （ P 〉 0.05 ）. A receiver-operating characteristic curve showed that the area under the curve of BNP and ANP were 0. 97 and 0. 85 respectively. The AUC between ANP and BNP had significant difference （ P 〈 0.01 ）. The plasma BNP concentration between LVEF （ left ventricular ejection fraction ） 〉 40% BNP （ 1 096.7 ± 656. 6 ） ng/L and LVEF 〈 40% BNP（2 659.4 ± 743. 5 ）ng/L patients had significant difference （P 〈 0. 05 ）. There was no significant difference between these two groups of plasma ANP concentration[ （931.6 ± 320.9 ）ng/L, （974. 3 ± 555.6） ng/L] （ P 〉 0. 05 ）. Condusion The plasma BNP concentration had more value than the ANP in diagnose of HF. BNP, LVEF and NYHA were identical for reflection the left ventricle function. So BNP was a good index of classify heart failure.

关 键 词：利钠肽 脑 心钠素 心力衰竭 充血性 

分 类 号：R541.6[医药卫生—心血管疾病]